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Canada’s Mental Health Blueprint Balances Provincial, National Strategies

The mental health action plan being promulgated in Canada focuses on education, research, tracking illnesses and services, and collaboration between the national and local governments to deliver services.

As far as volume goes, the Canadian document "A Call for Action: Building Consensus for a National Action Plan on Mental Illness and Mental Health" isn’t all that impressive—only 37 pages. But if the plan, or even parts of it, are implemented, they could pack quite a wallop in the mental health world.

One part of the plan has to do with better educating Canadians about mental illness. The plan proposes, for instance, that national educational materials about the nature of mental disorders and their impact on Canadians should be developed, that the topic of mental health should be introduced into school curricula, and that members of the justice system develop alternatives to incarceration for mentally ill people.

A second part of the plan concerns mental health research. For instance, since there is no organized mental health research agenda in Canada, the plan recommends that under the Canadian Institutes of Health Research, a Canadian Institute of Mental Illness and Mental Health Research should be formed.

A third part of the plan has to do with mental health epidemiology. It argues for the creation of a national program to track mental illnesses in Canadians and to document and evaluate mental services delivered.

Finally, a fourth part of the plan has to do with the implementation of a national policy framework that would cross provinces and territories, yet not intrude on their local powers. For example, Canadian psychiatrists have traditionally been trained for hospital work and private practice, not for working in community mental health facilities, yet there is an urgent need for them in the latter. Thus, national models of community mental health care, as well as ways of compensating psychiatrists for participating in those models, need to be explored.

Although Canadian psychiatrists would like to see all the recommendations in the plan implemented, they nonetheless have their favorites depending on their own specialties and perspectives. For example, Elliot Goldner, M.D., a mental health policy researcher at the University of British Columbia, would like to see the implementation of "minimum standards for mental health services and of a clear accountability mechanism. Part of that would be that there is a commitment to procedures that would document the outcome in services—that there would be a measuring of outcome, changes, quality, safety."

Pamela Forsythe, M.D., a St. John, New Brunswick, psychiatrist and a past president of the Canadian Psychiatric Association, has a similar wish: "Being able to document what we are doing and tracking it. I think we need that to be able to argue credibly for funding at various levels. If someone now says, ‘Show me your figures,’ well, we are really very poorly equipped to do some of that."

Pierre Beauséjour, M.D., an Edmonton, Alberta, psychiatrist and one of the originators of the national action plan, believes that the plan’s most important recommendation is for a national cross-jurisdictional policy framework for mental health. The reason, he explained, is that "all too often, the federal Canadian government, provinces, and territories will argue over jurisdictions. For instance, the federal government might say, ‘We’re not going to do that because the provinces are doing it.’ Yet in the day-to-day reality of providing services in Canada, this is no longer realistic. It is not your role or my role, but our problem, so why don’t we work together to improve it?"

The "Call for Action" report is posted on the Web at www.cpa-apc.org/Public/Action/actionplancomplete.pdf.

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